What’s Next for Health Care Reform?

Lawmakers must heed public opinion and explain the proposals to average Americans.

As the Obama administration and Congress go back to the drawing board on health care reform, experts are warning that they must not only focus on the process—how to get enough votes to pass any legislation this year—but also pay more attention to public opinion and do a better job of explaining the proposals to average Americans. By its very nature, effective reform is complex—with many moving parts inextricably interconnected. Altering one part can weaken or destroy others. Lawmakers have to proceed with caution.

And as they start again, they need to address a critical question: What happened to sour a majority of people on reform in the 14 months between November 2008, when Barack Obama won the White House with an apparent mandate to overhaul the dysfunctional health care system, and January 2010 when Scott Brown won a special election in Massachusetts widely perceived as a rejection of reform legislation then on the table?

Brown’s unexpected victory—placing a little-known Republican in the traditionally Democratic Senate seat that became vacant with the death of Edward Kennedy, a longtime champion of health care reform—was a turning point. Senate Democrats lost the crucial 60th vote needed to block a Republican filibuster and pass legislation.

“As ugly as the process was, as imperfect as the legislation was, it was all absolutely about to happen except for the special election in Massachusetts,” says Drew Altman, president of the Kaiser Family Foundation, a nonpartisan health policy research group.

The election stopped reform in its tracks. Obama, however, responded by vowing to find a way through the impasse: “I’m not going to walk away from this just because it’s hard,” he said shortly after Brown’s win. “We’re going to keep working to get this done—with Democrats, I hope Republicans, anyone who is willing to step up.”

But as the politicians go forward, they might also cast a glance backward, Altman says. “I think the Democratic leadership missed the boat in not realizing that the inside fight [in Congress] is very different from the outside fight.”

Just before the presidential election, 62 percent of Americans said it was “more important than ever to take on health care reform,” while 34 percent disagreed, according to a Kaiser tracking poll. But since September 2009, all the major polls have shown that more people strongly oppose the Democratic proposals than strongly favor them. After the Massachusetts result, a Gallup poll found that a majority of Americans (55 percent) wanted lawmakers to suspend work on the legislation and consider alternatives, while 39 percent wanted them to pass it.

A central problem, though, is what “it” means. To date, Americans have yet to be presented with a single health reform bill they can examine to see how it affects them. Obama’s strategy—announcing his principles for reform but leaving it to Congress to hash out the details—resulted in five different committees coming up with widely differing proposals last year. By late December, those were reduced to two bills, from the House and Senate, which have much common ground but also major differences that perpetuate public confusion.

“I think the president could have done a great job of selling one bill if we’d had one, but we didn’t,” says Robert Blendon, professor of health policy and political analysis at Harvard’s School of Public Health. Instead, the messiness of the political process, the way the debate dragged on, the complexity of both bills and their changing provisions, he adds, “got people very, very worried.”